Mental health status in Nepal

Laxmi Poudel
Published on
Thursday June 11, 2020

Mental health is an integral part of health and wellbeing. It is more than the absence of mental disorders. Prevalence and disease burden of mental disorders are incredibly high globally, and the treatment gap is also huge, with about four in five people with mental illness in low- and middle-income countries receiving no effective treatment.

According to a World Health Organization (WHO) report of 2017, one in four people in the world will be affected by mental or neurological disorders at some point in their lives. Global burden of Mental Disease and Substance-related Disorder has increased from 10 percent in 2010 to 14 percent in 2017, estimated that depressive disorders would be the leading cause of global burden in 2030. The WHO report revealed that depression and anxiety are the two most common mental disorders worldwide affecting about 322 and 264 million people, respectively.

According to a WHO report of 2019, one person dies in every 40 seconds from suicide. Nepal’s WHO Country Profile data of 2018 showed non-communicable disease accounts for 66 percent of total deaths. Similarly, the Multi-Sectoral Action Plan for the Prevention and Control of Non-communicable Diseases (2014-2020) estimated that 18 percent of the NCD burden is due to mental illness. An estimated 20-30 percent population in Nepal is at risk of developing one or more mentally ill conditions.

The finding of this study showed that the prevalence of any form of mental disorders is 12.9 percent. Suicide is a leading cause of death, especially among women of reproductive age group (16 percent).

However, there are no national-level studies on mental disorders conducted in Nepal till date. A pilot study of the National Mental Health Survey, Nepal was conducted in three districts Dhanusha, Bhaktapur and Dolakha in 2018. The survey was conducted to assess the prevalence of mental disorders in Nepal, identify the help-seeking behaviour and barriers in accessing care among people with mental disorders, and to assess the impact and disability due to mental disorders in Nepal.

The finding of this study showed that the prevalence of any form of mental disorders is 12.9 percent. Suicide is a leading cause of death, especially among women of reproductive age group (16 percent).  In the 13-17 age group, the prevalence of any form of mental disorders is 11.2 percent with major depressive disorder 0.7 percent and anxiety-related disorder 5.2 percent. Suicidality among adolescents is 8.7 percent. While in 17 years and above age group prevalence of any form of mental disorders is 13.2 percent with major depressive disorder (3.4 percent), anxiety-related disorder 2.9 percent and suicidality among adults is 10.9 percent.

Some studies showed that there is a high prevalence of mental illness among those who directly experience the earthquake in 2015. But neither any policy nor any national-level intervention has been implemented.

Those data suggest an increasing trend of mental health-related problems. People with mental health problem face lots of stigma and discrimination from society, and sometimes even from the service provider, which leads to a treatment gap. Still, we don’t have any high priority programme to address these growing mental health issues even though WHO’s comprehensive mental health action plan 2013-2020 was adopted at the 66th World Health Assembly.

The plan aims to promote mental wellbeing, prevent mental disorders, and reduce the mortality, morbidity and disability of persons with mental disorders. It is the first action plan on mental health in the history of the WHO.

Till date, our services depend on the Mental Health Policy 2053, which was formulated a long time ago. So it’s time that we endorsed the new mental health policy addressing the current issues. Although an attempt was made to bring in the new policy in 2073, it is still in draft form. The National Health Policy 2076 was formulated to address the health-related provision given by the Constitution of Nepal 2072. So, now the government is trying to bring new Mental Health-related strategies addressing the National Health Policy 2076 that has given some priority to mental health programme too.

There are lots of national and international organisations like KOSHISH Nepal, Transcultural Psychosocial Organization (TPO) Nepal, Centre for Mental Health and Counseling (CMC) Nepal, Tarangani Foundation among others working in the field of mental health. But there has been little effort to expand the outreach of mental health service. So the government should take the primary responsibility for making mental health services available and accessible to the general populace.

For better implementation of services, human resources development and creating new positions for mental health professionals, including a psychiatric nurse, is of immense need in the government health system.

Mental health is still a neglected issue in Nepal. Unlike other national health programmes, mental health is not given much priority. It is considered as a part of the non-communicable disease, and hence there is no separate division/section for the mental health programme.

Few national-level programmes and protocols address the mental health problem in the country. Some of them are Standard Treatment Protocol for mental health 2073, Community Mental Health Care Package 2074, Basic Health Service Package 2075, Procedure for Rehabilitation of People with Psychosocial problem 2076, Minimum Service Standard for Hospital 2075.

Initially, Primary Health Care Revitalization Division (PHCRD) was taking the primary responsibility for the mental health programme in Nepal. The PHCRD organised the International Conference on Mental Health in February 2018, first of its kind in Nepal. But now the NCD and Mental Health Section is working as a focal unit since the fiscal year 2074/2075. This section is established under the Epidemiology and Disease Control Division (EDCD), Department of Health Services. Even though some programmes have been started, the mental health programme has been shadowed by the NCD plan and programme.

Few national-level programmes and protocols address the mental health problem in the country. Some of them are Standard Treatment Protocol for mental health 2073, Community Mental Health Care Package 2074, Basic Health Service Package 2075, Procedure for Rehabilitation of People with Psychosocial problem 2076, Minimum Service Standard for Hospital 2075.

Now we are in this pandemic situation caused by Covid-19. We have to understand that this pandemic affects not only physical health but also mental health. Mental health problems related to this pandemic situation are caused by uncertainty, economic crisis, loss of loved ones etc. In this regard, a number of national programmes and interventions have been launched to address physical health. Yet, there is hardly any national programme related to mental health, even though some NGOs/INGOs are actively working in this situation.

So, the government needs to focus on the psychological consequences of this situation and make a specific plan and programme in collaboration with those independently working NGOs/INGOs to reach out to the public and address the basic mental health issue timely.

 Poudel is a nursing officer at Bir Hospital and pursuing a master’s in Advanced Psychiatric Nursing at Maharajgunj Nursing Campus.

 

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